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The infection usually begins with one eye, but may spread easily to the other.Viral conjunctivitis shows a fine, diffuse pinkness of the conjunctiva, which is easily mistaken for the ciliary infection of iris (iritis), but there are usually corroborative signs on microscopy, particularly numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a punctate keratitis. Symptoms consist of redness (mainly due to vasodilation of the peripheral small blood vessels), swelling of the conjunctiva, itching, and increased lacrimation (production of tears).Reactive arthritis is highly associated with HLA-B27.Conjunctivitis is associated with the autoimmune disease relapsing polychondritis.The gritty and/or scratchy feeling is sometimes localized enough for patients to insist they must have a foreign body in the eye. Bacteria such as Chlamydia trachomatis or Moraxella can cause a non-exudative but persistent conjunctivitis without much redness.Bacterial conjunctivitis may cause the production of membranes or pseudomembranes that cover the conjunctiva.
A patch test is used to identify the causative allergen in the case where conjunctivitis is caused by allergy.
Though very rare, hyperacute cases are usually caused by Neisseria gonorrhoeae or N. Chronic cases of bacterial conjunctivitis are those lasting longer than 3 weeks, and are typically caused by Staphylococcus aureus, Moraxella lacunata, or gram-negative enteric flora.